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General NPI Number Information
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NPI Number | 1982778155
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Entity Type | Individual
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Provider Name | MARK ALAN KENDALL MD
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 1502 SE 28TH ST SUITE 4
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City | BENTONVILLE
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State | AR
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Zip | 72712-3988
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Country | US
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Telephone | 479-464-9191
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Fax | 479-464-8840
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Provider Business Mailing Address
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Address Line | 4905 S 45TH ST
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City | ROGERS
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State | AR
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Zip | 72758-8935
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Country | US
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Telephone | 479-464-9191
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Fax | 479-464-8840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | E3659
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License Number State | AR
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